Long‐term physical and psychiatric morbidities and mortality of untreated, deferred, and immediately treated epilepsy

Author:

Ren Tianrui1ORCID,Li Yingtong1,Burgess Michael1,Sharma Sameer1ORCID,Rychkova Maria2,Dunne John34,Lee Judy4,Laloyaux Cédric5,Lawn Nicholas4,Kwan Patrick126ORCID,Chen Zhibin126ORCID

Affiliation:

1. Department of Neurosciences, Central Clinical School Monash University Melbourne Victoria Australia

2. Department of Medicine, Royal Melbourne Hospital University of Melbourne Melbourne Victoria Australia

3. Discipline of Internal Medicine, Medical School University of Western Australia Perth Western Australia Australia

4. Western Australian Adult Epilepsy Service Perth Western Australia Australia

5. UCB Pharma Brussels Belgium

6. School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia

Abstract

AbstractObjectiveIn Australia, 30% of newly diagnosed epilepsy patients were not immediately treated at diagnosis. We explored health outcomes between patients receiving immediate, deferred, or no treatment, and compared them to the general population.MethodsAdults with newly diagnosed epilepsy in Western Australia between 1999 and 2016 were linked with statewide health care data collections. Health care utilization, comorbidity, and mortality at up to 10 years postdiagnosis were compared between patients receiving immediate, deferred, and no treatment, as well as with age‐ and sex‐matched population controls.ResultsOf 603 epilepsy patients (61% male, median age = 40 years) were included, 422 (70%) were treated immediately at diagnosis, 110 (18%) received deferred treatment, and 71 (12%) were untreated at the end of follow‐up (median = 6.8 years). Immediately treated patients had a higher 10‐year rate of all‐cause admissions or emergency department presentations than the untreated (incidence rate ratio [IRR] = 2.0, 95% confidence interval [CI] = 1.4–2.9) and deferred treatment groups (IRR = 1.7, 95% CI = 1.0–2.8). They had similar 10‐year risks of mortality and developing new physical and psychiatric comorbidities compared with the deferred and untreated groups. Compared to population controls, epilepsy patients had higher 10‐year mortality (hazard ratio = 2.6, 95% CI = 2.1–3.3), hospital admissions (IRR = 2.3, 95% CI = 1.6–3.3), and psychiatric outpatient visits (IRR = 3.2, 95% CI = 1.6–6.3). Patients with epilepsy were also 2.5 (95% CI = 2.1–3.1) and 3.9 (95% CI = 2.6–5.8) times more likely to develop a new physical and psychiatric comorbidity, respectively.SignificanceNewly diagnosed epilepsy patients with deferred or no treatment did not have worse outcomes than those immediately treated. Instead, immediately treated patients had greater health care utilization, likely reflecting more severe underlying epilepsy etiology. Our findings emphasize the importance of individualizing epilepsy treatment and recognition and management of the significant comorbidities, particularly psychiatric, that ensue following a diagnosis of epilepsy.

Funder

UCB Pharma

Publisher

Wiley

Subject

Neurology (clinical),Neurology

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